Monday, November 29, 2010

Maintaining a Smaller-Footprint Therapeutic Garden by Julie Brown

PHS 100
Warner Pacific College
November 29, 2010

This paper will serve as one of an initial collection of papers to be used for a hospital therapeutic garden maintenance manual. Often maintenance strategies and tolerance thresholds are misunderstood in the hospital setting. The manual is intended for horticultural therapists, maintenance providers (the gardeners), and healthcare staff. The goal of the manual is to clearly state purposes of the gardens, advocate for willingness to change standards in landscaping in favor of reduced-footprint influences, and increase awareness and respect of natural rhythms; to promote the understanding of universal design and its implications. An overall goal is to increase awareness of gardens in healthcare, AND to emphasize the necessity of properly trained gardeners.
The goal of this paper is to address the environmental portion of maintenance, which is usually the first principle people will accept and appreciate.

Maintaining a Reduced-Footprint Therapeutic Garden
The therapeutic garden is not the rare space it used to be. Hospitals, care centers, and one park in Portland, Oregon have built therapeutic gardens to enhance the treatment milieu. Using nature as a therapeutic medium is almost as old as humankind and new and novel in our present day. Lacking a standardized, one-definition explanation, we can find Therapeutic Gardens described as a natural space that supports an identifiable population while in agreement with universal design; "often with a specific purpose, such as encouraging seniors to get outside for exercise, sunlight, and fresh air; or allowing children to 'blow off steam' during a hospital visit; or helping patients learn to use a wheelchair on outdoor surfaces before leaving the hospital. They should be designed using the most current research available. This is called evidence-based design " ( Universal design is best described as a design to include and be usable by as many people as possible without the need for adaptations.
The Portland Memory Garden (PMG) is located in Ed Benedict Park, 104 SE Bush St. is well used by the neighborhood and the larger community, but was designed specifically for people with memory disorders, including Alzheimer's disease and dementia. Garden features that address memory disorders and physical frailty include a circular design to bring the visitor back to a central place, and so if a person wanders they cannot get lost or be stuck in a dead end. From the main entrance which is slightly elevated, a caregiver has a view of the entire garden. Many seating areas invite frequent rests. Shade, cover, and bathroom facilities also address comfort and safety; the Memory Garden is maintained for safety, with careful plant selection, pruning for open spaces and high visibility. The most effective safety feature is the main gate that can be closed to allow the dementia visitor to walk freely and their caregiver to relax knowing their loved one cannot wander away. Other activities in the garden include special events: weddings, engagement and Quinceria photos because of the lovely backdrop. The garden is the site of regular and scheduled community events with young families and bicycle clubs and senior facilities. The reader is encouraged to see much more at the Portland Memory Garden website at With all of this human activity, it is unthinkable to have fussy, high maintenance plants sprayed with poisonous pesticides. So, how is the therapeutic garden maintained to favor sustainability and what are principles and changes we can make to reduce our footprint there?
What to change
Responsible environmental practices and the therapeutic garden share similar principles: kindness to garden visitors and kindness to the earth. The whole person is valued and treatment is based on the least invasive methods. The garden respects the soil and the life found there, and uses the least toxic pest treatments. How can we care for the garden with a gentler, more thrifty, and less invasive touch? We can change the way we landscape. The changes needed to address the future and sustainability are in our attitudes and perceptions of beauty and attitudes toward healing. Real change begins with attitude.
This writer's attitude is also (my) opinion based on 10 years of work in therapeutic gardens, and most of that in hospital gardens. It is not backyard gardening where we can plant with few restrictions and putter around on Saturdays, neither is it landscape maintenance that treats vast areas in minimum time and uses stock industrial strength plants. The tolerance threshold for each element, pests, grooming and pruning, is unique to each garden; more respect is given the natural life cycle and the possibility of nature solving imbalances. The therapeutic garden considers wildlife an equally important part of maintenance and respect for natural cycles. The garden must also work within a budget. Still, the most important attitude change I have experienced is understanding that plants need our care only because we put them in our care. The care given also reflects that given to the hospitalized patient and family, so we must be careful to respect and treat each element of the garden (family) with extreme value.
The Right Plant in the Right Place
Because we put them in our care it is right and just to cause little disruption to the natural environment. We use the “right plant in the right place” as the basis for almost all further plans and decisions. The right plant is happy where it is…it requires less attention, which means less water, fertilizer, pest control measures, less time on the clock caring for it. The adage about self change, "it's easier to put on slippers than to carpet the whole world" applies well to small-footprint gardening. The right plant does not require a change in the immediate environment (soil pH, water, fertilizer), that plant's cultural requirements will fit into the immediate environment because it is native to the area or from similar environment. Taking cues from nature we can build healthy soil, conserve water, and use organic gardening techniques.
Plant the right plant in soil build with organic material and use an appropriate mulch, one that is found in nature. Ideal soil contains 50% solid material, minerals and organic matter, and 50% open pore space for water, air passage, earth worms and other creatures. Compost, leaves, manure, holds water and makes the nutrients needed for strong and healthy plants available to plant roots. It keeps the soil light and friable and allows roots to penetrate. Organic material supports the microbial life that in turn breaks down more organic material and makes nutrients available to the plants (Reiley, H., Shry, C., 1997. pgs. 32-38). More information on building soil, improving structure, can be found at Follow the many links for even more information.
A word on changing attitudes and natural rhythms and systems: allow the therapeutic garden to slip naturally into fall and winter. Yes, we are called to complete our fall clean up before the fungi have a place to incubate, (so do clean up old wet leaves) but to honor the cycle and allow perennial seeds to remain on the stem. Finches and other small winter birds love Rudbeckia, sunflower, and Echinacea seeds. Educate visitors and encourage them to appreciate old brown seeds for their part in the winter cycle and the nourishment of little birds. Cultivate appreciation for the system, the elements working together, each affecting the other in some way.
Water conservation
An excellent online resource for basic garden water conservation is found at, website of the Regional Water Providers Consortium, which promotes cost-efficient use, wise stewardship, and protection of our water resources with the goal of meeting the values of members and the needs of future generations. The Consortium educational materials include a downloadable book of water-wise plant choices for the Pacific Northwest. Conservation tips, design, and strategies to employ: use a rain barrel. They hold 55 gallons of rain water to supplement or replace regular watering. Mulch with organic material to prevent excess evaporation. The rain garden is a no-extra-resource-needed specialty sink garden that establishes plants with spring rain and runoff, and survives the summer without supplemental water. The rain garden is a product of design and plant selection that trades beauty for less water down the storm drain.
Again, the right plant will not need excess water, that is by its second year. Drought tolerant means after the plant is established.

Pest review
Make careful and informed decisions for pest problems and grooming. Any chemical controls will affect beneficial insects also. Much better to provide biological and mechanical controls for pests. Biological controls are predators: insects that feed on or otherwise use plant pests and disease. A tiny wasp lays eggs in a tinier caterpillar or white fly for example, or a thousand Ladybugs released on an aphid infestation will control the aphids (Flint & Gouveia, 2001, pgs 98, 99, 104). A control that depends on the changed attitude concerns the hop vine. If you cannot tolerate aphids, don't plant hops. If you love hops, be willing to live with aphids. Treat with ladybugs in June, an learn about the ladybug life cycle. Hunting and picking slugs by night is a darkly satisfying mechanical control. To sum up, never use chemicals. They wash into drains and into sewer systems or the water supply. Chemicals are indiscriminate: the will kill butterflies, bees, lacewings, spiders and more. Instead, use the right plant; the right plant will not be easily stressed, which weakens and makes it susceptible to disease and insects.
The time has long come to cease a heavy handed human style of taming the landscape. The changes needed to address the future and sustainability as the relate to the garden are in our attitudes and perceptions of beauty, the appreciation for natural rhythms, and our willingness to refrain from invasive procedures. A holistic approach in people takes in mind body spirit; with nature a whole approach is location, selection, and an eye for true beauty. The environment impacts all three. Real change begins with attitude.

Flint, M.L., & Gouveia, P. (2001). IPM in Practice. Oakland, CA.: University of California.
Reily, H., & Shry, C., (1997). Introductory Horticulture. Albany, N.Y. Delmar Publishers

1 comment:

Timothy said...

you may also find Good Nature's Love Your Stream, Rain Garden and Low Impact Living posters good teaching tools. We designed them to change the way people build and maintain their homes. See Rain Gardens poster & Clean Water Practices to Learn. See web Good Nature Publishing